Becker's Hospital Review

71 CIO / HEALTH IT Jonathan Bush: 'Let's give AI the decidedly unsexy job of cleaning out the administrative muck' in healthcare By Julie Spitzer T o really make headway with artificial intelligence, healthcare should think smaller than "headline-grabbing moonshots," and instead, make computers tackle healthcare's most mundane tasks, ath- enahealth President, CEO and Chairman Jonathan Bush wrote in an op-ed for the Har- vard Business Review. "Excessive paperwork and red-tape is the sewage of modern medicine," he wrote, add- ing that inefficient administration results in an estimated 14 percent of wasted healthcare spending. "Let's give AI the decidedly unsexy job of cleaning out the administrative muck that's clogging up our medical organizations, sucking value out of our economy, and liter- ally making doctors ill with stress." Mr. Bush wrote that other breakthroughs in healthcare, like the first organ transplant or ro- botic surgery, are oen hailed as "heroic," but the most valuable advancements in healthcare tend to be more simple such as handwashing before births and C-sections. He suggested one aspect of health AI could tack- le is faxes, which remain a common method of communication in the industry. Some of the fax- es providers receive have nothing to do with their organization, nor do they contain any struc- tured text, which leaves staff to decipher each document — a task that takes, on average, two minutes and 30 seconds. Athenahealth, however, married machine learning with business-process outsourcing to automate the categorizing of fax- es. e solution has reduced time-per-fax for its practices to one minute and 11 seconds. "We are in the midst of a burnout crisis among U.S. physicians. ey're crushed by adminis- trative overload and feel they are becoming box-tickers rather than clinicians," Mr. Bush wrote. "Applying AI to the work that doctors detest presents a path to redemption for the health IT industry … We need to rebuild con- fidence in the promise of technology to free up provider time and enhance care delivery." Mr. Bush believes that using AI to automate physicians' everyday tasks could pave the way for other, bigger developments, like a cure for cancer. "Using AI to relieve scut work will allow them to focus again on what they love most and where they create the most value: the patient encounter," he wrote. n Mayo Clinic uses 'ambient intelligence' to find actionable EHR data in ICUs: 5 things to know By Jessica Kim Cohen R ochester, Minn.-based Mayo Clinic rolled out an ap- plication to flag actionable data for clinicians working in intensive care units, three of the health system's physicians wrote in an article for Harvard Business Review. EHRs contain a variety of important medical data, including diagnoses, observations, treatments and lab results. How- ever, when treating critical care patients, this information can become overwhelming for physicians. To combat this challenge, Mayo Clinic assembled a team to integrate "am- bient intelligence" into clinical workflows. Ambient intelligence, according to the authors, is a "set of decision-making tools powered by data on and insights into clinicians' goals, work environments, strengths and performance constraints." The goal of the program was to create a tool that delivers the right information to the right clinicians at the patient's bedside. Here are five things to know about Mayo Clinic's ambient intelligence application. 1. The team built an EHR interface for clinicians in the ICU, called Ambient Warning and Response Evaluation, or AWARE. The application offers a real-time overview of every ICU in the Mayo Clinic system, including represen- tations of each patient with notes on required tests, scans and procedures, to inform clinicians' decision-making. 2. The AWARE application notifies clinicians of potential omissions after analyzing the patient's condition. For exam- ple, the feature "Sepsis Dart" monitors patients in ICUs to determine whether a physician is implementing timely and accurate best practices for diagnosing and treating sepsis. 3. To create the application, Mayo Clinic assembled a mul- tidisciplinary team of clinicians and researchers to design clinical informatics tools. The team identified ICU clinicians with a "very high mental, or cognitive, workload who con- tinuously have to filter important information out of the cluttered environment," according to the authors, and con- ducted 1,500 interviews during a two-year period. 4. The clinical informatics team applied insights from these interviews to determine roughly 60 pieces of patient in- formation that proved "crucial" for patient care. These 60 items were selected from tens of thousands of pieces of data that came through the EHR, according to Harvard Business Review. The most important information included vital signs, alongside observations such as cough strength. 5. Mayo Clinic deployed AWARE in its Rochester, Minn.- based ICUs in 2012, and expanded the application to its Phoenix, Scottsdale, Ariz., and Jacksonville, Fla., campus- es in 2014. Since then, officials at the health system have determined the application saves clinicians three to five minutes on chart review per patient each day, along with improving patient outcomes in the ICU. n

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